Drugs & Aging

, Volume 31, Issue 3, pp 225–232 | Cite as

Prevalence and Impact of Fall-Risk-Increasing Drugs, Polypharmacy, and Drug–Drug Interactions in Robust Versus Frail Hospitalised Falls Patients: A Prospective Cohort Study

  • Alexander Bennett
  • Danijela Gnjidic
  • Mark Gillett
  • Peter Carroll
  • Slade Matthews
  • Kristina Johnell
  • Johan Fastbom
  • Sarah Hilmer
Original Research Article

Abstract

Background

Several measures of medication exposure are associated with adverse outcomes in older people. Exposure to and the clinical outcomes of these measures in robust versus frail older inpatients are not known.

Objective

In older robust and frail patients admitted to hospital after a fall, we investigated the prevalence and clinical impact of fall-risk-increasing drugs (FRIDs), total number of medications, and drug–drug interactions (DDIs).

Methods

Patients ≥60 years of age admitted with a fall to a tertiary referral teaching hospital in Sydney were recruited and frailty was assessed. Data were collected at admission, discharge, and 2 months after admission.

Results

A total of 204 patients were recruited (mean age 80.5 ± 8.3 years), with 101 robust and 103 frail. On admission, compared with the robust, frail participants had significantly higher mean ± SD number of FRIDs (frail 3.4 ± 2.2 vs. robust 1.6 ± 1.5, P < 0.0001), total number of medications (9.8 ± 4.3 vs. 4.4 ± 3.3, P < 0.0001), and DDI exposure (35 vs. 5 %, P = 0.001). Number of FRIDs on discharge was significantly associated with recurrent falls [odds ratio (OR) 1.7 (95 % confidence interval [CI] 1.3–2.1)], which were most likely to occur with 1.5 FRIDs in the frail and 2.5 FRIDs in the robust. Number of medications on discharge was also associated with recurrent falls [OR 1.2 (1.0–1.3)], but DDIs were not.

Conclusion

Exposure to FRIDs and other measures of high-risk medication exposures is common in older people admitted with falls, especially the frail. Number of FRIDs and to a lesser extent total number of medicines at discharge were associated with recurrent falls.

Supplementary material

40266_2013_151_MOESM1_ESM.docx (35 kb)
Supplementary material 1 (DOCX 34 kb)

References

  1. 1.
    Soriano TA, DeCherrie LV, Thomas DC. Falls in the community-dwelling older adult: a review for primary-care providers. Clin Interv Aging. 2007;2(4):545–54.PubMedCentralPubMedGoogle Scholar
  2. 2.
    WHO global report on falls prevention in older age. Geneva: World Health Organisation; 2007.Google Scholar
  3. 3.
    Hill KD, Wee R. Psychotropic drug-induced falls in older people a review of interventions aimed at reducing the problem. Drugs Aging. 2012;29(1):15–30.PubMedCrossRefGoogle Scholar
  4. 4.
    Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319(26):1701–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Bates DW, Pruess K, Souney P, et al. Serious falls in hospitalized patients: Correlates and resource utilization. Am J Med. 1995;99(2):137–43.Google Scholar
  6. 6.
    Ahmed N, Mandel R, Fain MJ. Frailty: an emerging geriatric syndrome. AJM. 2007;120(9):748–53.CrossRefGoogle Scholar
  7. 7.
    Khandelwal D, Goel A, Kumar U, et al. Frailty is associated with longer hospital stay and increased mortality in hospitalized older patients. J Nutr Health Aging. 2012;16(8):732–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Hartikainen S, Lonnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. J Gerontol. 2007;62A(10):1172–81.CrossRefGoogle Scholar
  9. 9.
    Gnjidic D, Hilmer SN, Blyth FM, et al. High-risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther. 2012;91(3):521–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Leipzig R, Cumming R, Tinetti M. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc. 1999;47(1):30–9.PubMedGoogle Scholar
  11. 11.
    Leipzig R, Cumming R, Tinetti M. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc. 1999;47(1):40–50.PubMedGoogle Scholar
  12. 12.
    Souchet E, Lapeyre-Mestre M, Montastruc JL. Drug related falls: a study in the French pharmacovigilance database. Pharmacoepidemiol Drug Saf. 2005;14(1):11–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Campbell A, Robertson M, Gardner M, et al. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc. 1999;47(7):850–3.PubMedGoogle Scholar
  14. 14.
    Ziere G, Dieleman J, Hofman A, et al. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol. 2006;61(2):218–23.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Van der Velde N, Stricker BHC, Pols HAP, et al. Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study. Br J Clin Pharmacol. 2007;63(2):232–7.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Van der Velde N, Stricker BH, Pols HA, et al. Withdrawal of fall-risk-increasing drugs in older persons: effect on mobility test outcomes. Drugs Aging. 2007;24(8):691–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Johnell K, Klarin I. The relationship between number of drugs and potential drug–drug interactions in the elderly—a study of over 600 000 elderly patients from the Swedish prescribed drug register. Drug Saf. 2007;30(10):911–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Gnjidic D, Johnell K. Clinical implications from drug–drug and drug–disease interactions in older people. Clin Exp Pharmacol Physiol. 2013;40(5):320–5.PubMedCrossRefGoogle Scholar
  19. 19.
    McMahon CG, Cahir CA, Kenny RA, et al. Inappropriate prescribing in older fallers presenting to an Irish Emergency Department. Age Ageing. 2014;43(1):44–50Google Scholar
  20. 20.
    Bjorkman IK, Fastbom J, Schmidt IK, et al. Drug–drug interactions in the elderly. Ann Pharmacother. 2002;36(11):1675–81.PubMedCrossRefGoogle Scholar
  21. 21.
    Astrand B, Astrand E, Antonov K, et al. Detection of potential drug interactions—a model for a national pharmacy register. Eur J Clin Pharmacol. 2006;62(9):749–56.PubMedCrossRefGoogle Scholar
  22. 22.
    Katz S. Assessing self-maintenance—activities of daily living, mobility and instrumental activities of daily living. J Am Geriatr Soc. 1983;31(12):721–7.PubMedGoogle Scholar
  23. 23.
    Inouye SK, Bogardus ST Jr, Baker DI, et al. The hospital elder life program: a model of care to prevent cognitive and functional decline in older hospitalized patients. Hospital elder life program. J Am Geriatr Soc. 2000;48(12):1697–706.PubMedGoogle Scholar
  24. 24.
    Hilmer SN, Perera V, Mitchell S, et al. The assessment of frailty in older people in acute care. Australas J Ageing. 2009;28(4):182–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Perera V, Bajorek BV, Matthews S, et al. The impact of frailty on the utilisation of antithrombotic therapy in older patients with atrial fibrillation. Age Ageing. 2009;38(2):156–62.PubMedCrossRefGoogle Scholar
  26. 26.
    Johnston CF, Hilmer SN, McLachlan AJ, et al. Population pharmacokinetics of gentamicin: the impact of frailty and implications for dosing. Clin Pharmacol Ther. 2010;91:S113–4.Google Scholar
  27. 27.
    Charlson M, Szatrowski TP, Peterson J, et al. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51.PubMedCrossRefGoogle Scholar
  28. 28.
    Russell MA, Hill KD, Day LM, et al. Development of the falls risk for older people in the community (frop-com) screening tool. Age Ageing. 2009;38(1):40–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Haider SI, Johnell K, Thorslund M, et al. Trends in polypharmacy and potential drug–drug interactions across educational groups in elderly patients in Sweden for the period 1992–2002. Int J Clin Pharmacol Ther. 2007;45(12):643–53.PubMedCrossRefGoogle Scholar
  30. 30.
    Lea M, Rognan S, Koristovic R, et al. Severity and management of drug–drug interactions in acute geriatric patients. Drugs Aging. 2013;30(9):721–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Pasina L, Djade CD, Nobili A, et al. Drug–drug interactions in a cohort of hospitalized elderly patients. Pharmacoepidemiol Drug Saf. 2013;22(10):1054–60.PubMedGoogle Scholar
  32. 32.
    Mino-Leon D, Galvan-Plata ME, Doubova SV, et al. A pharmacoepidemiological study of potential drug interactions and their determinant factors in hospitalized patients. Rev Invest Clin. 2011;63(2):170–8.PubMedGoogle Scholar
  33. 33.
    Best O, Gnjidic D, Hilmer SN, et al. Investigating polypharmacy and drug burden index in hospitalised older people. Intern Med J. 2013;43(8):912–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Woolcott J, Richardson K, Wiens M, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–60.PubMedCrossRefGoogle Scholar
  35. 35.
    Hilmer SN, Mager DE, Simonsick EM, et al. Drug burden index score and functional decline in older people. Am J Med. 2009;122(12):1142–9.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    McCusker J, Kakuma R, Abrahamowicz M. Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol. 2002;57(9):M569–77.CrossRefGoogle Scholar
  37. 37.
    Haasum Y, Fastbom J, Johnell K. Institutionalization as a risk factor for inappropriate drug use in the elderly: a Swedish nationwide register-based study. Ann Pharmacother. 2012;46(3):339–46.PubMedCrossRefGoogle Scholar
  38. 38.
    Lawlor D, Patel R, Ebrahim S. Association between falls in elderly women and chronic diseases and drug use: cross sectional study. BMJ. 2003;327(7417):712–7.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Tromp AM, Pluijm SM, Smit JH, et al. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol. 2001;54(8):837–44.PubMedCrossRefGoogle Scholar
  40. 40.
    Dedhiya SD, Hancock E, Craig BA, et al. Incident use and outcomes associated with potentially inappropriate medication use in older adults. Am J Geriatr Pharmacother. 2010;8(6):562–70.PubMedCrossRefGoogle Scholar
  41. 41.
    Cherubini A, Eusebi P, Dell’Aquila G, et al. Predictors of hospitalization in Italian nursing home residents: the ULISSE project. J Am Med Dir Assoc. 2012;13(1):84.e5–10.Google Scholar
  42. 42.
    Seymour R, Routledge P. Important drug–drug interactions in the elderly. Drugs Aging. 1998;12(6):485–94.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Alexander Bennett
    • 1
    • 2
    • 3
  • Danijela Gnjidic
    • 1
    • 2
    • 3
    • 5
  • Mark Gillett
    • 1
    • 4
  • Peter Carroll
    • 1
    • 6
  • Slade Matthews
    • 6
  • Kristina Johnell
    • 7
  • Johan Fastbom
    • 7
  • Sarah Hilmer
    • 1
    • 2
    • 3
  1. 1.University of Sydney, Northern Clinical SchoolSydneyAustralia
  2. 2.Royal North Shore Hospital, Clinical Pharmacology and Aged CareSydneyAustralia
  3. 3.Kolling Institute of Medical Research, Ageing and PharmacologySydneyAustralia
  4. 4.Royal North Shore Hospital, Emergency DepartmentSydneyAustralia
  5. 5.University of Sydney, Faculty of PharmacySydneyAustralia
  6. 6.University of Sydney, Pharmacology DepartmentSydneyAustralia
  7. 7.Aging Research Center, Karolinska Institutet and Stockholm UniversityStockholmSweden

Personalised recommendations